Saudi Arabia confirms three more coronavirus infections in a growing cluster involving a health-care facility. Two of the three new patients have already died.

A coronavirus can be seen in this colourized transmission electron micrograph. Saudi Arabia confirmed on Sunday another three cases, bringing the total in the eastern part of the country to 13.

By:Helen BranswellThe Canadian Press, Published on Sun May 05 2013

Saudi Arabia has confirmed three additional coronavirus infections in a growing cluster that involves a health-care facility in the eastern part of the country.

Limited details have been divulged. But the information that is available raises the spectre of person-to-person spread.

Some details of the new cases were provided Sunday by Dr. Ziad Memish, the country’s deputy health minister. Memish submitted the information to ProMED-Mail, an Internet-based infectious disease tracking system.

“So far there is no apparent community transmission and transmission seem linked to one HCF (health-care facility),” Memish said in a short posting that revealed that two of the three new cases are already dead and one is on a breathing machine in critical condition.

The new cases bring the Saudi cluster to 13 infections, with seven deaths. Globally there have been 30 infections with the new virus, 18 of them fatal.

Experts watching the Saudi outbreak with concern were quick to parse Memish’s statement.

“While it’s not explicitly stated that it’s person-to-person (spread), with no evidence of an animal reservoir in the hospital, the only conclusion that can be drawn is that this is person-to-person,” said infectious diseases expert Michael Osterholm.

And given the number of cases and the range of dates of illness onsets, “we cannot rule out multiple generations of spread,” he said.

The first known case in the Saudi health-care cluster got sick on April 14. The most recent person to become ill started to have symptoms on May 1.

The incubation period of the disease — the time it takes for an exposed person to develop symptoms — is not completely clear. But there is certainly enough time between these cases for several generations of spread to have taken place.

“This is far too wide to be an incubation period,” Osterholm said. “This (event) is much more complicated than that.”

Experts who have been following this virus — a member of the same family as the SARS virus — have been watching for hospital outbreaks. That’s because spread within hospitals was a key feature of the SARS outbreak. Many of the people who caught the infection were health-care workers or hospital patients.

“All of us are painfully reminded that the early acceleration of the 2003 SARS epidemic occurred around the hospital-related transmission of the virus,” Osterholm said. “We can only hope that this is not déjà vu all over again.”

The start of this outbreak was first reported to the World Health Organization late last Wednesday. At that time, there were seven cases, five of whom had already died. On Friday, Saudi authorities informed the WHO that three more cases had been confirmed. Sunday’s announcement brings the total to 13.

Since the first known cases of this infection occurred, Jordan, Qatar, the United Arab Emirates, Britain and Saudi Arabia have reported infections.